Smokeless tobacco: epidemiology, health effects and cessation strategies.

Smokeless tobacco is an extremely addictive substance with a high rate of use in certain demographic groups, such as adolescents and Native Americans. In the past 20 years, the use of smokeless tobacco has almost tripled. Health risks include leukoplakia (a premalignant oral lesion), oral cancer and systemic nicotine effects such as elevated blood pressure and serum cholesterol levels. To avoid or control these effects, family physicians should identify patients who use smokeless tobacco and encourage and support cessation efforts. Patients who are unsure about quitting need the risks of their habit personalized, and those who are actively trying to stop using smokeless tobacco need emotional and, in some cases, therapeutic support (e.g., nicotine replacement therapy). The family physician should encourage patients who appear motivated to stop using smokeless tobacco to set a quit date in the very near future. However, all smokeless tobacco users--regardless of their motivation to quit--need to be followed to ensure compliance with cessation advice or to detect medical complications from use of this form of tobacco.